BGC

APPLICATION FORM

SAMARTH A SUBBANNAVAR
Employee Name: ___________________________________________________________________
(First) (Middle) (Last)

002AZP744
IBM Employee No : __________________

Employment Record
Note: If you are a fresher, please specify “NA” in all the fields below

DXC TECHNOLOGY
Employer 1 Name (Most recent ): ___________________________________________________

11569541 09/JUL/2021
EMP ID:__________________________ Last working day: ___________________________
(DD/MMM/YYYY)
(DD/MMM/YYYY)

INFORMATION RELEASE AUTHORIZATION (TO BE SIGNED BY THE CANDIDATE)

I certify that the statements made in this application are valid and complete to the best of my knowledge.
I understood that false or misleading information may result in termination of employment
If upon investigations, any of this information is found to be incomplete or inaccurate, I understand that I will be
subject to dismissal at any time during my employment. I hereby authorize IBM and/ or any of its subsidiaries or
affiliates, and any persons or organizations acting on its behalf to verify the information presented on this
application form and to procure an investigative report or consumer report for that purpose. I hereby grant authority
for the bearer of this letter to access or be provided with full details of my previous records.
In addition, please provide any other pertinent information requested by the individuals presenting this authority. I
hereby release from liability all persons or I authorize to contact my present employer.
I have read, understand and by my signature consent to these statements.

SAMARTH A SUBBANNAVAR
Employee Name: ___________________________________________________________________
(First) (Middle) (Last)

Samarth A Subbannavar Digitally signed by Samarth A Subbannavar

Date: 2021.07.15 00:52:59 +05'30'
Signature: __________________________________________________

15/JUL/2021 15/JUL/2021
Signed Date: ____________________________ Effective Date: _____________________________
(DD/MMM/YYYY) (DD/MMM/YYYY)